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Greetings,

Today I will discuss donor density and how it affects the hair transplant procedure. Donor density is the amount of follicles per cm squared in the donor region. A secondary factor relating to density is the hair count, which is the number of hairs in the donor region. This is determined by finding the average follicular density per cm squared and then the average number of hairs per follicle and multiplying the two numbers. The average scalp has between 60-100 follicular units per cm squared and the average hair count is between 2.3-2.7 hairs per follicle. If the majority of the follicles are 2 hair follicles as opposed to 3 hair follicles then the overall hair count will be less. This is why not only the number of follicles is important, but the average number of hairs per follicle as well. The higher the hair count and follicle count, the greater the donor density. The greater the donor density the more hair that can be moved from the donor region to the areas of thinning. The donor region is an unchangeable area whether we do FUE or FUT to harvest the donor hair in the hair transplant procedure. This is why a high donor density and high donor hair count will lead to the ability to move more donor follicles to the areas of thinning.

I hope this helps to clarify donor density and how it impacts a hair transplant procedure.

All the best,

Marc Dauer, MD

Greetings,

Today I will discuss my approach to younger patients that seek out hair transplant procedures. It is very important that he hair transplant surgeon proceeds slowly and carefully in younger patients. It is not uncommon for young men in their early 20’s to approach me seeking hair transplantation. The issue is that in individuals this young it is very hard to accurately determine how severe their hair loss will ultimately be. Thus it is difficult to assess an accurate treatment plan over the long term, which is an essential component of our jobs as hair transplant surgeons. Since every individual only has a finite amount of donor follicles to donate to the areas of balding, we need to have a course of action for not only the amount of hair loss that the patient has at the moment, but the eventual end point of the patients hair loss in the future. This is so we can conserve donor hair for the future for the affected areas that will need it later. Sometimes young men in their early 20s wish to have their hairline restored to the way it was only a few years prior. This is not a good approach as is can result in an unnaturally low hairline later with not enough donor hair to fill in all the areas of baldness behind it.

I prefer to start my younger patients on Propecia and Rogaine which can help restore some hair, and in many cases greatly slow the progression of hair loss, especially in younger individuals. I have these patients follow up with me periodically so that I can assess their continuing degree of loss. In some cases I will perform a procedure in a patient as young as 25, but I will insist on a regimen of Propecia and Rogaine. Also, I create a very conservative hairline in these patients and don’t use too much donor hair, thus conserving donor hair for future procedures.

Hair loss can be psychologically debilitating for many and especially young individuals. As hair transpant surgeons it is our job to approach these patients in the proper manner, so that the right decision can be made as to when and how to proceed with the hair transplant procedure.

All the best,

Marc Dauer, M.D.

Greetings,

Today I will discuss the custom cut recipient blade sizes in hair transplant procedures  that I use to create the recipient sites for my hair transplant grafts. I have a machine which allows me to cut custom sized blades. Typically my blades range in size from .5mm-1.1mm and I have blade sizes in every size in between in .05mm increments. This allows me to use the smallest possible blade for the patients natural follicular units. The hair type and caliber are defining characteristics that determine which size blade to use. Typically I try to find the smallest possible blade which still allows for easy placement. An extra .1mm opening may not seem like much, but when multiplied by 1500-3000, which is the number of recipient sites I create in a typical hair transplant procedure, an extra .1mm can add up to significantly more injury to the scalp and circulation, which in most cases is not necessary. I also custom cut my blades with a 45 degree angle at the end and I angle the deepest portion of the blade so that it is at the superior aspect of the incision. This means that the blade also causes less injury to the scalp circulation and positions the graft at a more acute angle which gives a better final result. Minimizing damage to the scalp and the vascular bed minimizes scar tissue in the scalp and thus minimizes the potential of “shock loss” (which I will address in another blog entry).

I hope this blog entry clarifies why the blade size is very important in Hair Transplant Procedures.

All the best,

Marc Dauer, MD

Greetings,

Sometimes when I meet a patient for the first time in consultation, they come to me with their mind made up as to which harvest procedure for the hair transplant they wish to undergo. Other times they come to me with no idea as to which harvest method for the hair transplant that they prefer. The Internet has been an amazing tool to educate patients regarding all aspects of hair transplant procedures, however there is a huge amount of misinformation in the Internet as well. Often it is difficult for the average consumer to differentiate between the truth and the fiction. To further complicate things, some Hair Transplant surgeons have their own agendas as well. These physicians may only be proficient in either FUT or FUE, and may then try to steer patients towards the procedure that they are more comfortable with. In other instances, the physician may have purchased an expensive piece of equipment that he needs to pay for, and then will steer patients towards the procedure which helps to pay off the equipment.

When I meet with patients the first thing I do is pay close attention to the hairstyle they wear when they come into my office. How short their hair is, how it is combed, product in the hair, hair color, etc. These are all clues that help me to understand the patient as an individual. In addition, between the family history of hair loss and the patients physical exam, I do my best to estimate how severe the patient’s hair loss will progress over time. I explain in depth the pros and cons of FUT hair transplant versus FUE hair transplant and tell the patient that I have no vested interest in which procedure the patient decides to have. I truly enjoy performing both FUT and FUE. My only interest is that the patient undergoes the procedure that suits them best. Not just in the short term but in the long term as well. That is part of my duty to my patients. I encourage my patients to take their time in deciding which procedure suits them best, so that they make the right decision. Not a quick decision that could prove to be wrong in the long term.

All the best,

Marc Dauer, MD

Greetings,

Today I wold like to discuss the term Hair Transplant Or Hair Transfer. This term has become synonymous with the process of moving hair follicles from the donor zone on the scalp to areas of thinning or balding. The term Hair Transplant has always bothered me, as the term transplant is typically used to describe the donation of an organ from one individual to another. The hair taken from one individual will not grow if placed on another person unless both individuals are identical twins. Therefore, in actuality the term hair transplant is a misnomer as we are never taking hair from one person to transplant onto another. What we are actually performing is a hair transfer. We move hair follicles from the permanent donor zone on the back and sides (this is the hair that is immune to the process of genetic balding) to the areas of thinning. I would like to encourage others to begin to use the term hair transfer when discussing the process we perform as I believe it will help more people to understand what is involved in the process we routinely call hair transplant procedures.

All the best,

Marc Dauer, MD

Greetings,

Today I will discuss microscopic dissection in Hair Transplant procedures. Since the advent of Follicular Unit Hair Transplantation there are many different ways that physicians employ their staff to dissect the donor strip into individual follicular units in the process of hair transplant procedures, that is the groupings of hair that naturally occur on the scalp that we seek to move to the areas of thinning. There are many different types of microscopes that people use to dissect grafts and many different levels of magnification. Some physicians only have their staff use magnifying glasses on light boxes. I personally have my staff dissecting our grafts using brand new state of the art microscopes with 10x magnification and LED lighting. These microscopes are much more expensive than the typical microscopes but I believe they perform a superior job in dissecting the grafts. The 10x magnification is necessary to visualize the follicle in it’s entirety and allow for optimal dissection and the LED lighting provides excellent visualization while generating almost no heat (which typical lighting generates and can cause the grafts to dry out thus diminishing their chances of survival). Lessor magnification can result in the loss of intact follicles that cannot be visualized under lower magnification. This is turn can lead a lower survival of grafts in the hair transplant procedure.

In summary, state of the art high powered LED lit microscopes are more expensive, but superior in creating healthy follicular units for use in hair transplant procedures.

All the best,

Marc Dauer, MD

Greetings,

Today I will demonstrate a case I recently performed utilizing FUE (Follicular Unit Extraction) to harvest the individual follicles and subsequently transplanted the follicles into and eyebrow scar. Traditionally I would not usually perform FUE in an eyebrow transplant case as it only requires a small incision in order to harvest the number of follicles necessary in order to restore typical eyebrows to normal appearing density. In patients who insist on shaving their hair extremely short (#2 buzz cut or shorter) FUE is a better option in order to make sure that the scar does not show through. In a small FUE case I do not have to shave the entire donor area, and can shave a small strip of hair to harvest the donor follicles and then the patient can cover the donor region by combing the hair above over the shaved area. As you can see from these results the transplanted follicles into the scar grey very nicely and the patient was very happy with the final outcome. I have also used FUE to harvest follicles from the neck in order to transplant into mustache scars (in patients with cleft palate deformities and others) and other beard scars with excellent results. Below I have shown the before and after photos of this patient with the eyebrow scar.

All the best,

Marc Dauer, M.D.

Greetings,

Today I will discuss the scabs that form on the transplanted grafts immediately after the Hair Transplant procedure. Typically the crusts around the transplanted grafts form overnight. In my typical treatment I place a thin layer of antibiotic ointment on the grafts immediately post procedure. I also give all of my patients a copper peptide containing solution that I have formulated and call “Heal Spray”. I instruct my patients to spray on the grafts every 3-4 hours for the first 3-5 days. I have found that the copper peptide solution serves not only to keep the grafts moist, but it also loosens the crusts sooner and allows for quicker healing time and shedding of all the scabs. I also give my patients a special shampoo I have formulated called “Thicken” that contains a number of follicle thickening agents as well as coltar, which is used to treat a variety of different forms of inflammation and seems to calm the scalp down and reduce inflammatory properties that can cause scalp irritation. I encourage my patients to wash their hair with the Thicken shampoo beginning day 1 after their procedure by mixing a small amount of shampoo and water in a bowl and pouring it over the head. The Heal spray combined with the Thicken shampoo tends to get rid of most of the crusts around the transplanted follicles in 5-7 days which allows for a quicker return to normal appearance and a better growth potential of the grafts.

All the best,

Marc Dauer, M.D.

Greetings,

Today I will discuss an important concept in Hair Transplant Procedures known as “the illusion of density”. The typical density of follicles in a non balding scalp or healthy donor region is anywhere between 60-100 follicles per cm2. Usually the number is in the 70-85 range. Keep in mind that when I state follicles, the follicles may be single hair, 2 hair, 3, hair, or even 4 hair follicular units. Every individual has a different amount of each, but the average is about 2.5 hairs per follicle, with some having a slightly higher number and some slightly lower. The general rule is that once thinning of hair is noticeable in any particular region, the individual has already lost 50% of the original amount of hair that was present in the region. That is why we can create the illusion of density by re-creating slightly more than 50% of the original hair that was present in any given region. The reason why this is so important is that in many individuals they will go on to lose a large amount of hair over a lifetime. This can lead many male patients to end up as norwood 6 or 7, which means they end up losing most of the hair on the top of their head. The only difference between Norwood 6 and 7 is whether the donor hair fringe on the sides stays high, or gradually lowers over time as well. So clearly there would never be enough hair in the donor region to re create the original amount of density over such a large area. By meticulously and artistically placing the follicles with discrete angles and orientations, and creating a hairline that allows for future hair loss and conservation of donor follicles for this future loss, we can re- create completely natural hairlines, with less hair than was originally present. Hair caliber and curl are major determining factors in the final cosmetic result with an increase in hair caliber by .1mm possibly adding up to 30% to the overall cosmetic density of the final result. Also, skin to hair contrast has a major effect on the final cosmetic density as well.

This is why it is so important to have a strong grasp on the artistic elements that allow us to create this natural hairline and placing the hairline in a location that conserves donor hair for future hair loss.

All the best,

Marc Dauer, MD

Greetings,

Today I will discuss discomfort associated with the Hair Transplant procedure. Many patients are anxious prior to the procedure that the pain will be extremely intense both during the procedure and after the procedure. I have also encountered patients who have been treated elsewhere who did experience significant discomfort either during their procedures or afterward. I can honestly say that the vast majority of my patients report very little discomfort both during the procedure and after the procedure. Typically the greatest discomfort is the first night post procedure and in most cases by the second day after the hair transplant, most of the pain has resolved.

The first thing I do when a patient arrives on the day of their procedure, after they have signed consent forms and all their questions have been answered, we give them a small amount of oral Valium in order to relax. To minimize the pain during the injections of the local anesthetic I use a massaging device that barrages the brain with vibratory sensation thus making the discomfort of the injections very minimal. I have used many different anesthetic devices in the past (The Wand, etc.) and without a doubt this is the most painless way to administer the local anesthetic. I extract the donor strip meticulously and close the donor area with a very fine suture. This also minimizes post procedure discomfort as compared to metal staples or thick sutures which can both be very uncomfortable.

There is never any post procedure pain in the transplanted region. Typically there is some discomfort the first evening after the procedure and the patient is given pain medication is order to alleviate this pain. Usually by the second day, most if not all of the pain is gone and the sutures have been described as “slightly annoying”. With FUE there is almost no discomfort starting day 1 after the procedure and there are no sutures.

I have met so many patients who were scared to undergo the procedure because of their fear of injections or their fear of the pain involved. Universally the feedback has been that the pain associated with the hair transplant procedure, whether by FUT (Strip Harvest Procedure) or FUE (Follicular Unit Extraction), is so much less than they were anticipating and would never again deter them from having a follow up procedure.

I hope this helps to alleviate some concern among prospective patients regarding discomfort during and after the hair transplant procedure.

All the best,

Marc Dauer, MD